10. Graves’ disease - diagnosis, etiology, clinical manifestation, treatment

Question 1

graves disease etiology ?

Answer 1

autoimmune
affects women more than men
genetic predisposition
infection -ebv

Question 2

when is the onset go graves diseases?

Answer 2

rare in children

40-60

Question 3

graves disease has what else concomitant autoimmune diseases?

Answer 3

vitiligo and alopecia aerata

Question 4

assessment of activity of graves disease orbitopathy ?

Answer 4

spontaneous pain =1
pain when moving globe = 1 
conjunctival edema = 1 
swelling of eyelids =  
swelling of plica = 1 
redness of conjuctiva = 1 
redness of eyelid =1

Question 5

assessment of severity of graves disease orbitopathy ?

Answer 5

0 = no signs and symptoms 
1 = only signs no symptoms 
2 = symptoms and signs 
3 = proptosis
4 = extra ocular muscle involvement 
5 = corneal involvement 
6 = optice nerve involvement = sight loss

Question 6

what is the regime of treatment in graves disease ?

Answer 6

carbimazol = 10-20mg ever 8-12 hrs
propythiouracil 100-200mg 6-8 hrs

maintenance :5-10 mg of methimazole
50-100mg - PTU

Question 7

there are two types of outcomes after the treatment what ae they

Answer 7

Hormonal remission :
hormonal levels are completely normal, but antibodies are still present
=> consider RAI or surgery as next optio

Immunologic remission:
—> antibodies are absent! There still a chance of redeveloping them, but for
moment the patient is cured from Graves’ disease

Question 8

Radioactive Iodine (RAI) Therapy is recommended for whom ?

and contraindicated in whole ?

and how long can it produce euthyroidism ?

what is the side effect

Answer 8

recommended age group is >40 years

Absolutely contraindicated in children, pregnancy, in cases with leucopenia,
in active Graves’ orbitopathy
initial treatment for suspected malignancy

euthyroidism for 6-12 months

hypothyroidism

Question 9

Treatment of Graves’ Orbitopathy?

Answer 9

mild
artificial tears (methylcellulose 1%), sunglasses
higher pillow in order to reduce periorbital edema

moderate
weekly intravenous
infusions of 250-500 mg Methylprednisolon for 8-12 weeks
Orbital radiotherapy with or without oral glucocorticoids

Question 10

can graves disease produce hypothyroidism ?

Answer 10

the same antibodies that are produced and are positive in the blood work, but this
time they do not stimulate the thyroid gland, they rather bind to the receptors,
but do nothing at all and block them